The Development of a Multidisciplinary Care Pathway for Patients with Inflammatory Bowel Disease Before, During and After Pregnancy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.1.1. Phase 1: Screening Phase
2.1.2. Phase 2: Project Management Phase
2.1.3. Phase 3: Diagnostic and Objectification Phase
- (a)
- The organization and team itself
- (b)
- The view of patients with IBD and their family
- (c)
- The available evidence and legislation
2.1.4. Phase 4: Development Phase
2.1.5. Phase 5: Implementation Phase
2.1.6. Phase 6 and 7: Evaluation and Follow-Up Phase
2.2. Definitions
2.3. Data Analysis
3. Results
3.1. Phase 1: Screening Phase
3.2. Phase 2: Project Management Phase
3.3. Phase 3: Diagnostic and Objectification Phase
3.3.1. Care Process and Project Goals
3.3.2. Retrospective Findings from Our Hospital Database
3.3.3. The View of Patients with IBD
3.4. Phase 4: Development Phase
3.4.1. Development of the Care Pathway IBD INFANT Wish
- (a)
- Preconception phase
- (b)
- Pregnancy phase
- (c)
- Postpartum phase
3.4.2. Development of Materials
4. Discussion
4.1. Main Findings
4.2. Methodological Considerations and Future Perspectives
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
IBD | Inflammatory Bowel Disease |
IBD INFANT Wish | IBD Multidisciplinary Family Planning UZ Leuven Care Pathway |
CCARE | Crohn’s Disease and Ulcerative Colitis Advanced Research |
CCV-vzw | Crohn & Colitis Ulcerosa Vereniging—vzw |
ECCO | European Crohn’s and Colitis Organization |
AGA | American Gastroenterology Association |
PIANO | Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes |
GP | General practitioner |
IQR | Interquartile range |
BCG | Bacillus Calmette–Guérin |
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Phase | Care Process Goals |
---|---|
Preconception phase | Provide patient education and counselling Health optimization Medication review and adjustment |
Pregnancy phase | Monitoring and support IBD disease management Assessment and management of pregnancy complications Awareness of specific vaccine limitations for the child Delivery planning |
Postpartum phase | Postpartum care and support Long-term follow-up |
Project Goals | Interpretation |
---|---|
Establishing evidence-based guidelines | Develop and update evidence-based guidelines for managing pregnant patients with IBD based on the latest research and clinical practice |
Training and education of the team members | Train healthcare providers on specific needs and management strategies for pregnant patients with IBD Offer continuous education opportunities to keep healthcare professionals informed about advancements in the field |
Enhancing patient education and support | Create educational materials and support programs for pregnant patients with IBD |
Quality improvement | Continuously monitor and evaluate the care pathway to identify areas for improvement |
Interdisciplinary collaboration | Encourage communication and collaboration among healthcare providers (e.g., gastroenterologists, obstetricians, IBD nurses, case managers midwifery, IBD dietitians) |
Patient-centered care | Tailor care pathways to the individual needs and preferences of patients Engage patients in shared decision-making processes regarding their treatment plans |
Variables | n | % |
---|---|---|
Maternal Characteristics | ||
Obstetric characteristics (n = 185) | ||
Abortion | ||
A0 | 134 | 72.4 |
A1 | 31 | 16.8 |
A2 | 15 | 8.1 |
A3 | 3 | 1.6 |
A4 | 2 | 1.1 |
Parity | ||
P0 | 107 | 57.8 |
P1 | 58 | 31.4 |
P2 | 15 | 8.1 |
P3 | 3 | 1.6 |
P4 | 1 | 0.5 |
P5 | 1 | 0.5 |
Gravida | ||
G1 | 85 | 45.9 |
G2 | 58 | 31.4 |
G3 | 20 | 10.8 |
G4 | 12 | 6.5 |
G5 | 7 | 3.8 |
G6 | 2 | 1.1 |
G7 | 0 | 0.0 |
G8 | 1 | 0.5 |
Usage during pregnancy | ||
Smoking (n = 187) | ||
Yes | 24 | 12.8 |
No | 163 | 87.2 |
Folic acid use (n = 155) | ||
Yes | 154 | 99.4 |
No | 1 | 0.6 |
Medication use during pregnancy (n = 193) | ||
Mesalazine | 25 | 13.0 |
Corticosteroids | 5 | 2.6 |
Thiopurine | 26 | 13.5 |
Methotrexate | 0 | 0.0 |
Biological therapy | 126 | 65.3 |
Infliximab | 40 | 20.6 |
Adalimumab | 23 | 11.9 |
Golimumab | 3 | 1.0 |
Vedolizumab | 34 | 17.6 |
Ustekinumab | 23 | 11.9 |
Risankizumab | 2 | 1.0 |
Small molecules | 0 | 0.0 |
Medication changed during pregnancy | 84 | 45.1 |
Biological therapy stopped during pregnancy | 66 | 52.4 |
Variables | n | % |
---|---|---|
Pregnancy Outcomes (n = 195) | ||
Live birth Miscarriage Elective termination of pregnancy (before week 22) Pregnancy termination at week 24 Stillbirth | 158 32 3 2 0 | 81.0 16.4 1.5 1.0 0.0 |
Mode of delivery (n = 156) | ||
Vaginal delivery Caesarean section Reason for caesarean section (n = 63) Obstetrical indication Patient with perianal fistulizing disease Patient with a pouch Patient’s wish Other | 93 63 41 14 5 1 2 | 59.6 40.4 65.1 22.2 7.9 1.6 3.2 |
Infant outcomes (n = 158) | ||
Preterm delivery 1 Low birth weight 2 Small for gestational age 3 Intra-uterine growth retardation (n = 143) | 14 12 20 9 | 8.9 7.6 12.7 6.3 |
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Share and Cite
De Dycker, E.; Lenie, S.; Ceulemans, M.; Geens, P.; Lambrechts, T.; Loddewijkx, E.; Paps, A.; Degry, J.; D’Hondt, C.; Matthijs, A.; et al. The Development of a Multidisciplinary Care Pathway for Patients with Inflammatory Bowel Disease Before, During and After Pregnancy. J. Clin. Med. 2025, 14, 2644. https://doi.org/10.3390/jcm14082644
De Dycker E, Lenie S, Ceulemans M, Geens P, Lambrechts T, Loddewijkx E, Paps A, Degry J, D’Hondt C, Matthijs A, et al. The Development of a Multidisciplinary Care Pathway for Patients with Inflammatory Bowel Disease Before, During and After Pregnancy. Journal of Clinical Medicine. 2025; 14(8):2644. https://doi.org/10.3390/jcm14082644
Chicago/Turabian StyleDe Dycker, Els, Sien Lenie, Michael Ceulemans, Patricia Geens, Tessy Lambrechts, Elien Loddewijkx, Ariane Paps, Justien Degry, Caroline D’Hondt, Annelies Matthijs, and et al. 2025. "The Development of a Multidisciplinary Care Pathway for Patients with Inflammatory Bowel Disease Before, During and After Pregnancy" Journal of Clinical Medicine 14, no. 8: 2644. https://doi.org/10.3390/jcm14082644
APA StyleDe Dycker, E., Lenie, S., Ceulemans, M., Geens, P., Lambrechts, T., Loddewijkx, E., Paps, A., Degry, J., D’Hondt, C., Matthijs, A., Vermeire, S., Sabino, J., Verstockt, B., Lannoo, L., Van Calsteren, K., & Ferrante, M. (2025). The Development of a Multidisciplinary Care Pathway for Patients with Inflammatory Bowel Disease Before, During and After Pregnancy. Journal of Clinical Medicine, 14(8), 2644. https://doi.org/10.3390/jcm14082644